Macular hole and serous pigment epithelial detachment in bilateral acquired vitelliform lesions

• Main Authors: Nana Yata, Tsutomu Yasukawa, Mihoko Kawamura, Yoshio Hirano, Yuichiro Ogura
• Format: Article
• Language: English
• Published: Elsevier 2020-06-01
• Series: American Journal of Ophthalmology Case Reports
• Subjects: Anti-vascular endothelial growth factor therapy; Macular hole; Photodynamic therapy; Serous retinal pigment epithelial detachment; Vitelliform lesions; Vitrectomy
• Online Access: http://www.sciencedirect.com/science/article/pii/S2451993620300244

Purpose: Acquired vitelliform lesions (AVLs) are associated with age-related macular degeneration and other variable macular disorders. AVLs often lead to outer retinal atrophy, sometimes accompanying a macular hole and choroidal neovascularization. The purpose of this study was to report a rare case with bilateral AVLs, in which one eye had accompanied a macular hole and the second eye a serous pigment epithelial detachment (sPED). Observations: A 66-year-old woman complained of bilateral metamorphopsia. AVLs were observed in the right eye and a flat sPED in the left eye. The best-corrected visual acuity (BCVA) was 20/17 in both eyes. Fluorescein angiography revealed local leakage in the right eye and pattern dystrophy-like hypofluorescence in both eyes. The sPED progressed with AVLs in the left eye and was treated with a combination therapy of intravitreal aflibercept, a sub-Tenon's injection of triamcinolone acetonide, and photodynamic therapy (IVA/STTA/PDT), which successfully flattened the sPED and sustained good vision for 4 years. The right eye was treated with intravitreal ranibizumab and tissue plasminogen activator, which enhanced absorption of the vitelliform material. However, 14 months later, a macular hole with typical metamorphopsia formed above a subretinal fibrotic scar at the vitelliruptive stage. Although pars plana vitrectomy closed the macular hole, enlargement of the outer retinal atrophy worsened the BCVA to 20/100. Conclusions and importance: We successfully treated one eye with a sPED with AVLs using the combination therapy of IVA/STTA/PDT, while the second eye with a macular hole secondary to AVLs ultimately developed outer retinal atrophy with visual loss.